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This leaflet is written for patients and their families. It provides information on transperineal biopsies of the prostate. The leaflet goes through the indications, benefits, risks, technique and post-operative care associated with this biopsy technique. Please note it is different to a transrectal ultrasound guided (TRUS) biopsy. 

What is a Prostate Biopsy?

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The prostate gland produces the white fluid that becomes part of the semen. It is located below the bladder and in front of the rectum and is roughly the size of a walnut. A biopsy involves taking small samples or cores of tissue from the prostate gland with a needle. These samples are then analysed by a histopathologist (doctor who diagnoses and studies disease by looking at samples under a microscope).

The biopsy can find out whether any of the prostate cells have become cancerous or, if there is pre-existing cancer, whether the cancer has changed. It can also diagnose other conditions such as the natural growth of the prostate that occurs with ageing or inflammation of the prostate. 

Why is a prostate biopsy needed?

Your Urologist will recommend a prostate biopsy if they believe there is a suspicion of prostate cancer. There are a number of reasons why they may have this suspicion. 

  1. A blood test may show a high level of prostate-specific antigen (PSA). This is a common marker for prostate cancer, PSA is a protein released into the blood by the prostate. Although it is not specific for prostate cancer, it is often raised if someone has prostate cancer. 
  2. You may have had an MRI scan which shows an abnormal area within the prostate.
  3. A previous biopsy may have shown no evidence of cancer, but the PSA blood test is still suspicious. 
  4. There may be a known diagnosis of prostate cancer, but treatment is not yet required. The biopsy is performed to monitor the progress of the cancer. 
  5. A lump or abnormality is found during a digital rectal examination. 

What does the procedure involve?

The transperineal technique is an alternative method for sampling the prostate compared with the older transrectal method. It involves taking the biopsy through the skin (perineum), which is the area between the scrotum and the anus. It is usually performed under sedation or local anaesthetic. This technique will target any abnormal areas seen on your MRI scan. Additionally other areas in your prostate may be biopsied. Taking the samples through the skin, which can be thoroughly cleaned, reduces the infection rate compared to taking samples through the back passage. There is no incision made in the skin and no stitches needed; it is simply a needle passing through the skin each time a sample is taken.  

What are the risks?

There are risks with every procedure; however, serious complications with this procedure are rare.

Infection can occur in about 1% of patients. Antibiotics are prescribed during the biopsy to reduce the risk of infection. However, if a fever develops, or if there is pain when passing urine, then it is recommended that medical attention is sought. Life-threatening infection (sepsis) is very rare (one in 500). If you feel unwell a few days after a biopsy (lethargy and fever) you should see a doctor that day. 

Blood in the urine is not uncommon and increasing fluid intake to flush the system should clear out any bleeding. However, if this persists, please contact the prostate cancer nurses or your GP to clarify the situation. If the bleeding is very significant (the colour of red wine) and/or you pass blood clots or you cannot pass urine you should attend your local Accident and Emergency department.

Blood in the semen is common and can take up to three months to clear. Occasionally men experience problems with erections, but this is almost always temporary.

The perineal skin can get bruised but rarely does bruising occur over the scrotum. This bruising can take two to four weeks to resolve. It is possible that the biopsy may cause prostate swelling that can lead to difficulty passing urine. This may mean that a catheter is required, and you should consult your urologist for their advice. This happens in one in 100 cases.

What will happen if I choose not to have a transperineal prostate biopsy?

We can monitor the prostate problem in association with your GP using PSA blood tests. Your doctor or nurse specialist will discuss this with you.

What should I expect before the procedure?

The procedure can be done either under local anaesthetic or sedation. This will be discussed with you when it is decided that you need the procedure. More detail is given regarding this in the next section. If you choose to have the biopsy under local anaesthetic, you will be awake throughout the procedure. You can also eat and drink beforehand. Additionally, no escort is required to accompany you home. If you have sedation, then you will be given medication into a vein in your arm that will make you unconscious during the procedure; most patients have no memory of the procedure afterwards. 

If you have chosen to have the procedure under local anaesthetic you do not need to fast and should continue to eat and drink as normal.

If you have chosen to have the procedure under local anaesthetic and you are on blood pressure medication you should continue to take your anti-hypertensive medication as normal either the night before or on the morning of your procedure.

If you have chosen to have the procedure under local anaesthetic and you are diabetic and on medication for this you should continue to take your diabetes medication as normal either the night before or on the morning of your procedure.
If you are taking aspirin 75mg daily you can continue with this.

If you are taking any other blood thinners such as:

  • Warfarin 
  • Clopidogrel
  • Rivaroxoban
  • Apixaban
  • Endoxaban
  • Dabigatran

Please make sure you have discussed with your clinic team when you need to stop them prior to the biopsy.

If you are having the procedure under sedation you will need to fast (no food six hours before; no water two hours before) and you will need someone to escort you home and stay with you overnight.

If you choose sedation you will receive an additional appointment for a “pre-assessment” to assess your general fitness and to do some baseline investigations. Once you have been admitted, you will be seen by members of the medical team which may include the consultant, urology doctor or your named nurse.

After checking for allergies, you will normally be given an intravenous/intramuscular injection of antibiotic at the time of your anaesthetic.

When you are admitted to hospital, you will be asked to sign the second part of your operation consent form giving permission for your procedure to take place, showing you understand what is to be done and confirming that you want to go ahead. Make sure that you are given the opportunity to discuss any concerns and to ask any questions you may still have before signing the form. It is preferable to have opened your bowels before the procedure.

What should I expect on the day of the procedure?

In the procedure room/theatre you will be assisted by staff to get on the procedure bed. You will be on your back with your legs up in some stirrups in front of you allowing the surgeon to reach the skin behind your scrotum. If you are having the procedure under sedation, it will be at this point you will be sedated. 

The surgeon will examine the prostate through the back passage (anus) before gently inserting the ultrasound probe into the rectum. This probe is 2cm wide and approximately 15cm long. Local anaesthetic is injected into the skin and inside around the prostate to make it go numb, which helps reduce pain during the procedure and when you wake up after the procedure. The procedure can be uncomfortable at times if you are having it under local anaesthetic. You will need to tolerate several injections and having the probe in your rectum for 10-15 minutes. After the biopsies have been done, a firm dressing will be applied to the perineum and held in place with a pair of disposable pants. A painkiller suppository is sometimes also given.

The surgeon will see you prior to discharge.

What happens immediately after the procedure?

You should be told how the procedure went and you should:

  • let the medical staff know if you are in any discomfort;
  • ask what you can and cannot do;
  • feel free to ask any questions or discuss any concerns with the ward staff and members of the surgical team; and
  • make sure that you are clear about what has been done and what happens next.

You will go home later the same day provided you are passing urine normally. Again, If you have sedation someone will need to accompany you home and be with you overnight in case you need help.

If you would like sedation but do not have an escort or someone who can stay with you overnight then another option is to stay in hospital overnight. You will need to tell us beforehand if this is the case. 

Driving after Biopsy

If you have had sedation, you should not drive for 24 hours after this. 

What should I expect when I get home?

When you leave hospital, you will be given a discharge summary. This contains important information about your stay in hospital and your procedure. If you need to call your GP or if you need to go to another hospital, please take this summary with you so the staff can see the details of your treatment. This is important if you need to consult another doctor within a few days of being discharged.

It is important that you:

  • drink twice as much fluid as you would normally for the first 48 hours;
  • maintain regular bowel function;
  • avoid physically-demanding activities.

Any discomfort can usually be relieved by simple painkillers.

What else should I look out for?

To reiterate; If you experience: 

  • a fever, shivering or develop symptoms of cystitis (frequency and burning on passing urine), you should contact the hospital. If it’s not possible to make contact this way, please go to A/E or contact your GP.
  • a lot of bleeding in the urine, especially with clots of blood, you should contact hospital. If it’s not possible to make contact this way, please go to A/E or contact your GP.

Are there any other important points?

All biopsies are reported and discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. The results will usually be given in person in a clinic one to two weeks after the procedure. You and your GP get a record of the results and a summary of the discussion. We sometimes need to order additional tests as a result of our discussions and, as a result, you may receive appointments for a bone scan or CT or PET scan.

Where can I get more information?

Prostate Cancer UK
Tel: 0800 074 8383

UCLH Macmillan Support and Information Service
Location: Ground Floor, Huntley Street, London, WC1E 6DH
Tel: 020 3447 8663 

Macmillan Cancer Support
Tel: 0808 808 00 00

UCL Hospitals cannot accept responsibility for information provided by external organisations.

Contact details

Clinical Nurse Specialists

Support Worker
07984 391124

Pathway Coordinator to Consultants
Tel: 020 3447 9194

Out of hours, please contact your GP or nearest Accident & Emergency Department